A nurse is reinforcing teaching about elimination with an adolescent who is paralyzed from the waist down following a spinal cord injury.
Which statement by the adolescent indicates a need for further teaching?

Choice A rationale:

Wheezing Wheezing is typically associated with respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD), rather than being a symptom of hyperkalemia.

Choice B rationale:

Cerebral edema Cerebral edema, or swelling in the brain, is not typically a symptom of hyperkalemia. It’s more commonly associated with traumatic brain injury, stroke, or brain tumors.

Choice C rationale:

Decreased deep tendon reflexes Decreased deep tendon reflexes can be a symptom of hyperkalemia. Hyperkalemia is a condition in which the potassium levels in your blood get too high. Potassium helps nerves send signals between your brain and the rest of your body. High levels of potassium can affect nerve function, leading to symptoms such as muscle weakness or decreased reflexes. Choice D rationale:

Hypoactive bowel sounds Hypoactive bowel sounds, or decreased or absent bowel sounds, are typically associated with conditions affecting the gastrointestinal system, such as ileus or bowel obstruction. They are not typically a symptom of hyperkalemia.

Choice A rationale:

Metabolic alkalosis is an acid-base imbalance characterized by excessive loss of acid or excessive gain of bicarbonate produced by an underlying pathologic disorder. It causes metabolic, respiratory, and renal responses, producing characteristic symptoms. One of the manifestations of metabolic alkalosis is cardiovascular abnormalities, such as atrial tachycardia. Therefore, placing the patient on continuous cardiac monitoring is a necessary action to assess the patient’s heart rate and rhythm and detect any abnormalities early.

Choice B rationale:

Insulin is not typically used in the treatment of metabolic alkalosis. Insulin is a hormone that regulates blood sugar levels. It’s not directly related to the body’s acid-base balance. Therefore, obtaining a prescription for insulin for the patient would not be a relevant action in this case.

Choice C rationale:

Administering sodium bicarbonate to a patient with metabolic alkalosis would not be appropriate. Sodium bicarbonate is a base and is often used to treat metabolic acidosis, a condition characterized by an excess of acid in the body. Giving sodium bicarbonate to a patient with metabolic alkalosis, a condition characterized by an excess of base in the body, could potentially worsen the patient’s condition.

Choice D rationale:

Having the patient breathe into a paper bag is a common treatment for respiratory alkalosis, not metabolic alkalosis.

Respiratory alkalosis is caused by hyperventilation, which leads to a decrease in carbon dioxide in the blood. Breathing into a paper bag helps to increase the amount of carbon dioxide the person inhales, helping to restore the acid-base balance. However, metabolic alkalosis is not caused by hyperventilation, so this treatment